Hospital Readmissions Take Toll In Pennsylvania

By ANDREW CONTE and LUIS FABREGAS

PITTSBURGH TRIBUNE-REVIEW

PITTSBURGH (AP) – Pennsylvania hospitals charged more than $1.25 billion in 2009 to treat patients who were readmitted for complications or infections that might have been avoided, a Tribune-Review investigation has found.

University of Pittsburgh Medical Center’s Presbyterian and Shadyside hospitals led the state with a combined 806 readmissions and charges totaling more than $67 million, according to the Trib’s analysis of the latest data from the Pennsylvania Health Care Cost Containment Council.

With higher average billing rates, several Philadelphia area hospitals were among the state’s highest in charges.

The more than 24,000 patients statewide caught in the revolving door of hospital visits pay an unknown cost physically and emotionally. Charlotte Velemirovich, 69, of Pittsburgh’s Westwood neighborhood was discharged Dec. 1 from Allegheny General Hospital after hip replacement surgery, but wound up back at the hospital barely a month later because of an infection she got during her initial hospitalization.

Hospitals nationwide have a financial incentive for readmitting patients rather than keeping them healthy and at home.

The $1.25 billion Pennsylvania hospitals charged for readmissions in 2009 would buy a flu shot for every American 60 and older.

Some readmissions are unavoidable, yet even when solutions to stop readmissions are developed that can be as simple as spending more time educating patients before discharge, hospitals lose money by fixing the problem. The average charge for every congestive heart failure patient readmitted to UPMC Presbyterian-Shadyside was $81,349, the data show. Multiplied by 70 cases, the charges in 2009 totaled more than $5.69 million.

Pennsylvania hospitals reported 24,197 readmissions in 2009 for people who came back within 30 days because of a complication or infection, according to the Trib analysis of state cost containment council data that included a custom report on readmission charges prepared exclusively for the newspaper. The council tracked readmissions and related charges for 158 hospitals statewide, but did not include children’s or specialty hospitals.

The true cost of readmissions remains a secret even to the public officials charged with monitoring waste. Most Pennsylvania hospitals are nonprofit, yet they are not required to say how much money they receive for treatments. Insurers do not have to say how much they spend either.

Temple University Hospital’s 381 readmissions were the 11th highest among the state’s hospitals in 2009, but the Philadelphia hospital had the second-highest total charges at nearly $60 million. Sandra Gomberg, president and CEO of Temple University Hospital, explained that charges can be an indicator of fluctuating costs, “like a buoy floating on the ocean surface.’’ But she said they are not related to the actual amount hospitals are paid. Confidentiality clauses with insurers preclude hospital administrators from saying how much they receive in payment, she said.

The state cost council rejected the Trib’s Right-To- Know Law request for actual payment information, saying state statute prohibits releasing that proprietary information. However, the council estimates Pennsylvania hospitals received about 26 cents for every dollar charged in 2009. That means readmissions for complications or infections that year cost about $327 million.

The newspaper’s analysis of the council data found:

 Nine of 20 hospitals with the most readmissions are in Western Pennsylvania, including six in Allegheny County and one each in Blair, Cambria and Westmoreland counties. The council counts UPMC Presbyterian and UPMC Shadyside as one hospital for reporting purposes, and their actual readmissions were 114 more than the state agency expected, based on factors that include the types of cases each hospital handles.

 Among the 20 hospitals with the highest total charges for readmissions, every one except UPMC Presbyterian- Shadyside and the North Side’s Allegheny General Hospital was from Southeastern Pennsylvania. Sixteen were from Philadelphia and its suburbs.

 Patients with congestive heart failure accounted for the most readmissions (3,144) and the highest charges (more than $174 million) among the 29 conditions the council tracks. Infectious pneumonia and chronic obstructive pulmonary disease also topped the list.

 Readmission charges varied widely for every procedure, often costing 10 times more at one hospital than at another. Hahnemann University Hospital in Philadelphia had an average readmission charge of $556,804 for each of 13 cases of chronic obstructive pulmonary disease, compared to an average of $4,583 for each of three cases at Titusville

Area Hospital in Crawford County.

Readmissions cost more than money. Patients can pay for readmissions with their good health, and sometimes their lives.

Former Steelers defensive end Dwight White died in June 2008 because of a blood clot in his lung, a complication his family blames on a previous back surgery in a lawsuit winding its way through Allegheny County Common Pleas Court. Lawyers for the University of Pittsburgh Medical Center, the hospital, doctors and others named as defendants have denied the allegations, court records state.

Alan Krug, 44, of St. Mary’s in Elk County, went to a hospital for back surgery in February 2008 and was readmitted days later because his rectum was torn during the procedure, court records show. Months later, when he returned to the hospital for a colostomy reversal, he bled to death, a lawsuit contends.

Velemirovich said the infection pain in her right leg that led to her readmission to Allegheny General was so intense, it felt like someone was trying to cut it off. She spent more than a month in rehabilitation at Kindred Hospital and uses a walker to get around. She was told the cost of her readmission was more than $80,000. She received a letter dated Jan. 26 from the hospital confirming she got the infection there.

Cutting readmissions costs hospitals money, but that will change in 2012 under the federal health care law. Under the rules, Medicare and Medicaid no longer will pay hospitals more when patients with many common conditions come back for treatments. Instead of hospitals making money from readmissions, they will assume the costs of treating people who return.

That shift got administrators’ attention, and many institutions are making plans to address the problem.

Even without changes to the federal law, hospitals need to reduce waste to survive, said Dr. Christopher Olivia, CEO of West Penn Allegheny Health System. Health insurance has become too expensive, and government programs are going broke.